How the US health care system makes it harder to stop coronavirus

Coronavirus patients -

April 25, 2020

(CNN)Everyone has gripes about the American health care system. But now that the US is facing a coronavirus pandemic, the flaws have far greater — and even deadly — repercussions.The issues go beyond early missteps by federal officials, such as delays in distributing testing kits.While countries around the globe are struggling to deal with the coronavirus, people in the US must contend with a fragmented health system where just going to get tested can mean hundreds or thousands of dollars in medical bills — a risk those in other developed countries don’t face.”When you get to a highly communicable disease, that’s when we all suffer the consequences,” said Alan Weil, editor-in-chief of Health Affairs, a health policy journal. “My fate is very much tied to everyone else’s fate.”Here are three problems the US must contend with:

Lack of coverage and high costs

The US is the only developed nation without universal health care. Nearly 28 million non-elderly Americans, or 10.4%, were uninsured in 2018, according to the most recent Census Bureau data available.This is an improvement from what it was before the Affordable Care Act was passed in 2010. That year, 46.5 million non-elderly people — or 17.8% — lacked coverage. But the uninsured rate has started ticking up again over the past two years.The uninsured largely depend on a patchwork of community clinics and hospital emergency rooms for care. This means they often wait until their conditions become serious before seeking medical help — which could lead to their infecting many others during viral outbreaks like coronavirus.

But even those who have insurance may not seek care that quickly, largely because they face hefty deductibles and out-of-pocket costs for doctor’s visits, emergency room trips and treatment.The roughly 153 million Americans who have insurance through their jobs have seen their deductibles double over the past decade, according to the Kaiser Family Foundation’s 2019 Employer Health Benefits Survey. A worker now has to shell out about $1,655 a year, on average, before coverage kicks in.Plus, more than a quarter of covered workers — including 45% of those at smaller firms — have an average deductible of at least $2,000 a year.”Addressing coronavirus with tens of millions of people without health insurance or with inadequate insurance will be a uniquely American challenge among developed countries,” tweeted Larry Levitt, executive vice president for health policy at Kaiser. “It will take money to treat people and address uncompensated care absorbed by providers.”Concerned that high costs may dissuade people from getting checked out if they feel ill, many insurers and several states arewaiving co-pays for the coronavirus test for certain policyholders. But patients will still have to pay for the visit, other testing and any treatment for the coronavirus or other illness they may turn out to have.

Lack of paid sick leave

Another weak point in the nation’s fight against the coronavirus’ spread is the lack of national standards on paid sick leave, a rarity among industrialized nations.Federal and state officials are asking those who feel ill to stay home from work, but that’s not easy for many to do if it means forgoing a paycheck or getting on the bad side of the boss.Nearly a quarter of workers don’t have paid sick leave, according to federal data. And among those in the leisure and hospitality industries, who often deal with the public at places like restaurants and hotels, fewer than half can take a paid sick day.Among the lowest-paid employees, only half have access to sick leave.And many gig economy workers, such as those who drive for Uber and Lyft and who deliver food, are considered independent contractors and don’t receive benefits such as sick days.

“Of course, another effect of the lack of paid sick leave is that many people will go to work sick, causing the virus to spread more widely,” Dean Baker, senior economist at the left-leaning Center for Economic and Policy Research, wrote in a blog post.Over the years, some states and municipalities have stepped in to fill the gap — a dozen states plus the District of Columbia, require employers to provide paid sick leave for certain workers. At least 18 cities and counties have done the same.However, some state legislatures have also banned municipalities from enacting paid sick leave laws.Meanwhile, fewer than 30% of workers can work from home, according to Bureau of Labor Statistics. Those who can are more likely to be in higher-paying industries, such as finance or professional services. But in leisure and hospitality, fewer than 1 in 10 are able to work from home.Congressional Democratic leaders are pushing to expand paid sick leave to try to contain the virus, a measure the White House has also weighed. President Donald Trump also said Monday he would press lawmakers to ensure assistance is available to hourly workers.

Lack of primary care doctors, ICU beds and respirators

Instead of rushing to the emergency room or urgent care, those who feel feverish or short of breath should call their doctor, federal officials advise. That will both minimize the chances to spread the coronavirus and avoid overburdening hospitals and clinics.But many Americans don’t have a regular primary care doctor, and those that do could have trouble reaching them after hours or on weekends, said Dr. David Blumenthal, a primary care physician and president of The Commonwealth Fund, a health care research and policy organization.The nation’s medical system is oriented to specialty care. Primary care doctors typically are paid less, and the field carries less prestige, he said.

The US has roughly 3 general or family practitioners per 10,000 people, compared to 7.5 in the United Kingdom, 9 in France and 13 in Canada, according to a Commonwealth Fund analysis.”We lack that front line of screening and advice that primary care can provide,” Blumenthal said, adding that these doctors are in a better position to decide whether their patients have pre-existing conditions that would require more treatment.While health officials say the vast majority of those diagnosed with coronavirus, formally known as Covid-19, will be able to recover at home, some will need to be hospitalized. If those numbers rise sharply, hospitals may have trouble accommodating them.Many hospitals have a limited number of intensive care unit rooms and staff trained to handle patients in them, said Eric Toner, a senior scholar at Johns Hopkins Center for Health Security.”Intensive care unit beds are incredibly expensive to build and maintain. We don’t have many more of them than we need on an average daily basis. So when we have an unexpected surge like we’re anticipating with COVID-19, we’ll exceed that capacity,” said Toner.That’s a main concern for John Hick, medical director of emergency preparedness for Minneapolis-based Hennepin Healthcare, which is already contending with flu season. Of the 400-plus ICU beds in the metro area, only a handful were available, he said last week.

If many coronavirus patients appear, some hospitals may have to take over other wings that contain a lot of technology, such as surgical recovery or cardiac units — requiring the postponement of other patients’ procedures, Toner said.”Unlike the Chinese, we can’t build hospitals in three days,” Blumenthal said.Having enough supplies, particularly N95 respirators, is also a concern, Hick said. Even though Hennepin had not seen any coronavirus patients as of late last week, dozens of people are coming in to be checked out. The staff uses the respirators if they suspect someone might have the illness.N95 respirators have been in short supply globally as countries treat their coronavirus patients. Last week, the federal government put out a solicitation to purchase 500 million of the devices over the next 18 months to refill America’s reserve supply.Meanwhile, hospitals like Hennepin that aren’t in hot spots have to make do.”The rest of us all get a percentage of what we usually order, but that doesn’t begin to keep up with what is required,” Hick said. “So we’re stuck.”

CNN’s Kathryn Vasel contributed to this report.

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